Pyloric stenosis notes
- 2. Pyloric stenosis is a narrowing of the pylorus, the opening from the stomach into the small intestine.
- 3. Pyloric stenosis or pylorostenosis is narrowing (stenosis) of the opening from the stomach to the first part of the small intestine known as the duodenum, due to enlargement (hypertrophy) of the muscle surrounding this opening (the pylorus, meaning "gate"), which spasms when the stomach empties
- 4. Pyloric stenosis occurs most often in infants younger than 6 months. It is more common in boys than in girls.
- 5. The cause of the thickening is unknown. Genes may play a role, since children of parents who had pyloric stenosis are more likely to have this condition.
- 6. Genes may play a role, since children of parents who had pyloric stenosis are more likely to have this condition
- 7. Normally, food passes easily from the stomach into the first part of the small intestine through a valve called the pylorus. With pyloric stenosis, the muscles of the pylorus are thickened. This prevents the stomach from emptying into the small intestine.
- 8. The gastric outlet obstruction due to the hypertrophic pylorus impairs emptying of gastric contents into the duodenum. As a consequence, all ingested food and gastric secretions can only exit via vomiting, which can be of a projectile nature.
- 9. Vomiting is the first symptom in most children: Vomiting may occur after every feeding or only after some feedings Vomiting usually starts around 3 weeks of age, but may start any time between 1 week and 5 months of age Vomiting is forceful (projectile vomiting) The infant is hungry after vomiting and wants to feed again
- 10. Other symptoms appear several weeks after birth and may include: Abdominal pain Burping Constant hunger Dehydration Failure to gain weight or weight loss Wave-like motion of the abdomen shortly after feeding and just before vomiting occurs
- 11. The condition is usually diagnosed before the baby is 6 months old. A physical exam may reveal: Signs of dehydration, such as dry skin and mouth, less tearing when crying, and dry diapers Swollen belly Olive-shaped mass when feeling the upper belly, which is the abnormal pylorus Ultrasound of the abdomen may be the first imaging test. Other tests that may be done include: Barium x-ray -- reveals a swollen stomach and narrowed pylorus Blood tests -- often reveals an electrolyte imbalance
- 12. Treatment for pyloric stenosis involves surgery to widen the pylorus. The surgery is called pyloromyotomy. If putting the infant to sleep for surgery is not safe, a device called an endoscope with a tiny balloon at the end is used. The balloon is inflated to widen the pylorus. In infants who cannot have surgery, tube feeding or medicine to relax the pylorus is tried.
- 13. The definitive treatment of pyloric stenosis is with surgical pyloromyotomy known as Ramstedt's procedure (dividing the muscle of the pylorus to open up the gastric outlet). This is a relatively straightforward surgery that can possibly be done through a single incision (usually 3–4 cm long) or laparoscopically (through several tiny incisions), depending on the surgeon's experience and preference.